摘要
目的:为布鲁氏菌病合并肝功能异常患者药物治疗方案的选择提供参考。方法:临床药师对石河子大学医学院第一附属医院收治的1例男性布鲁氏菌病合并肝功能异常患者的药物治疗方案进行分析,参考布鲁氏菌治疗指南及国内外临床资料,结合该患者肝功能异常变化提出用药建议。结果:该患者为慢性期感染,中度肝损伤,其肝功能异常为布鲁氏菌病常见的并发症。医师与药师会诊后,考虑到患者肝功能异常,首先静脉滴注左氧氟沙星(0.5 g,qd)进行抗感染治疗;待肝功能好转后,停用左氧氟沙星,改为静脉滴注利福平(0.6 g,qd)和口服多西环素(100 mg,bid)进行抗感染治疗。同时,静脉滴注还原型谷胱甘肽(1.8 g,qd)和甘草酸二铵(150 mg,qd)进行抗炎保肝治疗。治疗期间临床药师密切监测患者的不良反应,并对患者进行相关治疗的用药教育,以提高患者的依从性。用药10 d后,患者虽有部分肝功能指标没有恢复正常,但布鲁氏菌感染及肝功能异常症状好转,出院继续口服相同剂量的利福平和多西环素进行院外治疗。结论:布鲁氏菌病患者出现肝功能异常时,抗感染治疗应作为主要的治疗目标。临床药师应通过参考相关指南并结合临床实际,协助医师调整治疗方案,保证患者用药的安全性与有效性。
OBJECTIVE:To provide reference for the selection of drug treatment plan in patients with Brucellosis combined with liver dysfunction. METHODS:Clinical pharmacists analyzed drug treatment plan in a patient with Brucellosis combined with liver dysfunction in the First Affiliated Hospital of Medical College of Shihezi University. Referring to Brucella treatment guideline and domestic and foreign clinical information,the suggestions were put forward according to the change of liver dysfunction.RESULTS:The patient had chronic infection and moderate liver injury. The liver dysfunction in this patient was a common complication of Brucellosis. After consultation of doctors and pharmacists, in consideration of the abnormal liver function,intravenous drip of levofloxacin(0.5 g,qd) was given in the patient for anti-infection treatment. After the liver function was improved,levofloxacin was stopped,and intravenous drip of rifampin(0.6 g,qd) and oral administration of doxycycline(100 mg,bid)were given for anti-infection treatment instead;during the treatment period,intravenous drip of reduced glutathione(1.8 g,qd)and diammonium glycyrrhizinate(150 mg,qd)were given for anti-inflammatory and liver protecting treatment. During the treatment,the clinical pharmacists closely monitored ADR of patients,and carried out medication education for patients to improve the compliance. 10 d after medication,although some of the liver function indexes of the patient did not return to normal,but Brucellosis and liver dysfunction symptoms were improved. The patient could continue to take the same dose of rifampin and doxycycline after discharge. CONCLUSIONS:When the patients with Brucellosis have abnormal liver function,anti-infection treatment should be the main treatment target. The clinical pharmacists should refer to the relevant guidelines and combine with the clinical practice to help doctors adjust the treatment plan,so as to ensure the safety and effectiveness of the patients’ medication.
作者
尹雪妍
李静
张永军
YIN Xueyan;LI Jing;ZHANG Yongjun(College of Pharmacy,Shihezi University,Xinjiang Shihezi 832000,China;Dept.of Pharmacy,the First Affiliated Hospital of Medical College of Shihezi University,Xinjiang Shihezi 832000,China;Dept.of Clinical Education,the First Affiliated Hospital of Medical College of Shihezi University,Xinjiang Shihezi 832000,China)
出处
《中国药房》
CAS
北大核心
2020年第5期632-636,共5页
China Pharmacy
基金
2018年兵团科技攻关项目(No.2018AB017)
关键词
布鲁氏菌病
肝功能异常
临床药师
合理用药
Brucellosis
Liver dysfunction
Clinical pharmacist
Rational drug use
